We gave a basic overview of first-party claims in this article. Here, we go further into the topic, and discuss how to properly interact with your insurance company.
When you file a first-party claim under your own auto insurance, their investigation will be into the type of injuries and cost of treatment, not into whose fault the accident was.
There are four good reasons for filing a first-party claim:
- You live in a state with the no-fault statute, and you are required to by law.
- The at-fault driver was uninsured or underinsured.
- You need immediate funds, and can’t wait for the at-fault driver’s insurance company to finish their investigation.
- There were passengers in your car who were injured, and they are seeking compensation from your insurance company.
If you live in a state with no-fault insurance, or carry personal injury protection (PIP), the issue of negligence is irrelevant. In first-party claims, always keep in mind your insurance policy limits, as they govern the amount of compensation you can receive.
Conflict of Interest
When you purchase a vehicle liability policy, you’re buying insurance protection. Your insurance company’s duty is to protect your interests if you are injured or you injure someone else; however, that duty gets muddled when you file a first-party claim.
An immediate conflict of interest arises. The insurance company suddenly has dual responsibilities: to you and your fair compensation, and to itself and its effort to pay out as little as possible. Keep this in mind throughout the claims process.
Filing a First-party Claim
When a person files a claim with his own insurance company, the claim is considered a first-party claim. This is different than filing a claim against an at-fault driver’s insurance, which is referred to as a third-party claim. Here’s how to file a first-party claim…
Begin with a Telephone Call
As soon as possible after the accident, call your insurance company to let them know. This begins the claims process. Make sure you get the claim number for future reference. Your claim will then be assigned to an adjuster who will call you within a few days.
Get the Police Report
Police reports are usually available within two or three days after an accident. Go to the local police station and request a copy. There might be a small fee of under $10.00. In some cities, police reports are available online.
Prepare to Speak with the Claims Adjuster
It normally takes a day or two for the adjuster to call. Use this time to prepare. By the time the adjuster calls, she’ll already have a copy of the police report and a recorded statement from the other driver. She may have even spoken with the police officers and witnesses.
Be prepared to give the adjuster specific information, such as which ambulance company transported you, to which hospital, and which tests were performed. Have any notes you took, diagrams of the accident, and any other pertinent information in front of you. You can never have too much information.
Clearly describing your memory of the accident will help move your claim along. Even though negligence is not an issue, the adjuster can’t commit to paying any money until she completes her investigation.
Watch what you say. The adjuster will ask you questions about the accident. She’ll likely show concern about your injuries, but don’t allow her to minimize your pain and suffering.
She may begin by saying something like, “How are you feeling today, Mr. Smith?” In everyday polite conversation, a standard response is, “Fine, thank you.” But that’s not the right answer when speaking to a claims adjuster about your personal injury case. If you start off the conversation by saying you’re fine, you’re damaging your own credibility.
Allow Limited Access to Your Medical Records
The adjuster will need to review all your medical records before agreeing to pay the costs of extended treatment. Until she sees all those charts and bills, she probably won’t agree to pay for anything besides your ambulance ride and emergency room treatment.
She’ll ask you to sign a release form giving her permission to access your medical records. She can’t properly evaluate your injuries and resulting costs until she has the release.
Before you sign, read the release thoroughly. Be sure it’s a limited release that only gives access to your medical records related to the current injury. A general release could give the adjuster the right to request records from any of your doctors, for any illness, at any time throughout your medical history.
You don’t want to give the adjuster access to confidential information from doctors who have nothing to do with this claim. With a general release, an adjuster would be able to track down records of a previous injury and use them to minimize your present claim.
If possible, wait until the adjuster makes a determination before starting lengthy chiropractic or other non-medical treatment. Before you run up lots of expensive therapy bills, make sure the adjuster understands that your injuries were serious enough to require such treatment.
Send a Confirmation Letter
After speaking with the adjuster, send her a confirmation letter. In the letter, confirm that your claim is in process, and document your current injuries and ongoing treatment. The letter should be sent certified with return receipt requested (this proves you sent the letter on a specific date).
Example Confirmation Letter
April 23, 2014
Northern Palms Insurance Corporation
123 Main Street
Phoenix, AZ 85016
Re: Claim Number 12-F2968
Insured: John Smith; DOB 02/25/1971
Policy Number: KA445782-S
DOA (date of accident): 04/12/2014
Dear Ms. Jones:
Please let this confirm our conversation on April 22, 2014, when you and I discussed the facts related to an automobile accident I was involved in on April 12, 2014. During our conversation, I notified you of my intention to proceed under the Personal Injury Protection section of my insurance policy, referenced above.
At your request, I gave my recorded statement, in which I fully answered all your questions. I made clear that I was injured in the accident, and as a result have already incurred medical bills. I also made clear the injuries I sustained prevent me from working at this time.
I am under continuing medical care and will keep you informed of my condition. I will also send you written confirmation of my out-of-pocket expenses and lost wages.
Finally, please let this confirm my intention to fully cooperate in your investigation of my claim. If you have any questions, or if any of the above is not clear, please do not hesitate to contact me.
Stay in Touch with the Adjuster
You must keep the lines of communication open between you and the adjuster. You need to know what she’s thinking. Press her to commit to your claim and agree to fully compensate you for your injuries, including reimbursement for medical and chiropractic bills, out-of-pocket expenses, lost wages, and an amount for your pain and suffering.
There’s nothing wrong with calling an adjuster regularly to gauge her progress in the evaluation of your claim.
Get the Adjuster’s Approval for Continuing Treatment
Adjusters normally won’t question the medical treatment you receive immediately after an accident. But problems often start when the treatment becomes extended. One of the biggest mistakes people make is running up bills without first getting the adjuster to agree to pay for them.
You must press the adjuster to commit to your continuing treatment.
Subrogation is the legal right of one entity to make a claim against another entity to recover their losses. When an insurance company pays a first-party claim on behalf of their insured, they sometimes pursue the at-fault driver (and his insurance company) to recover the money they paid.
Some no-fault states permit their insurers to file a separate personal injury claim against the at-fault driver (if there was one). Your policy likely has a Subrogation Clause, detailing the specifics.
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